Volume 11 Issue 8, August 2014

Analysis of cardiovascular registry data suggests that cardiologists who practice femoral cardiac catheterization can convert to safer transradial approaches with a learning experience of 30–50 procedures. This conversion is associated with no loss of procedural success and no increase in serious adverse outcomes.

In May 2014, the FDA astutely stated that any decision to use aspirin should be an individual clinical judgement by health-care providers. Almost simultaneously, the MESA investigators formulated, but did not test, a hypothesis that coronary artery calcification scoring might aid health-care providers in making this judgement.

Mineralocorticoid-receptor antagonists (MRAs) have been shown to reduce adverse cardiovascular outcomes in high-risk patients with ST-segment elevation myocardial infarction (STEMI). Preliminary data suggest that MRAs might improve natriuretic-peptide profiles in patients with STEMI who do not have heart failure, but their clinical efficacy in this patient population requires further study.

¹⁸F-FDG is the most-commonly used tracer in PET imaging of atherosclerosis.¹⁸F-FDG uptake can be used to identify patients at the highest risk of clinical events and as a surrogate end point in clinical trials of antiatherosclerotic therapies. However, background myocardial uptake of ¹⁸F-FDG can make identifying high-risk coronary artery plaque difficult. Several novel PET tracers have, therefore, also been tested in atherosclerosis imaging. Here, Tarkin et al. review the role of state-of-the-art PET imaging of inflammation in atherosclerosis, including the rationale for this modality, and its current and future uses.

Percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO) is currently infrequently performed due to technical difficulty or perceived risk of complication. In this Review, Hoebers et al, provide a comprehensive overview of CTO–PCI and the selection criteria for those patients who might benefit from the procedure, which the authors believe should be performed more frequently to treat CTOs. The authors also discuss emerging technologies that might improve CTO–PCI.

The left atrial appendage (LAA) is the main location of thrombus formation in patients with atrial fibrillation. This Review by Romero et al. is focused on the pathophysiology, assessment, and clinical implications of stasis and thrombus formation in the LAA. The advantages and disadvantages of the available imaging modalities for LAA assessment are discussed, and the authors explore the role of cardiac imaging in the therapeutic use of LAA closure devices.

Cardiac resynchronization can be a useful therapy for patients with heart failure and abnormal ventricular contraction. However, up to half of patients do not respond to therapy. In this Review, Vernooy and colleagues discuss the selection of patients, positioning of pacing leads, timing of pacing, and management of patients after device implantation to improve the outcomes from cardiac resynchronization therapy.